Salt Consumption, Major Cause of Hypertension in Africans, Says Cardiologist

A Professor of Medicine and Consultant Cardiologist, S.A. Isezuo, has identified excessive  salt consumption, as a major contributor to  high blood pressure (HBP) among Africans, noting that studies suggest Black people excrete salt less efficiently than their white counterparts.

The cardiologist, who practises at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, said that despite the availability of several antihypertensive drugs, identifying the most effective treatment approaches for Black populations remains an important consideration in hypertension management.

Isezuo explained that the relationship between salt intake and high blood pressure (HBP) is linked to a condition known as salt sensitivity, characterised by a rise in blood pressure following increased salt intake and a reduction when salt consumption is restricted.

According to him, salt sensitivity may contribute to salt and water retention, expansion of plasma volume and constriction of blood vessels in the kidneys, particularly among individuals with low potassium levels. He added that salt sensitivity is also associated with increased blood pressure and microalbuminuria, a condition involving the presence of small amounts of albumin in the urine.

The cardiologist noted that the genetic factors associated with hypertension among Black people are believed to have evolved partly through adaptation to hot climatic conditions, particularly among populations in sub-Saharan Africa.

Speaking in an exclusive interview with Pharmanewsonline, Isezuo warned that the global burden of hypertension could worsen without urgent intervention. He cited a projection by the World Health Organisation (WHO) that affected individuals with hypertension may surpass 1.5 billion by 2030.

He therefore urged Nigerians to reduce their salt consumption significantly as part of efforts to prevent the development of hypertension and improve blood pressure control among those already living with the condition.

Highlighting evidence-based approaches to hypertension management in Black populations, Isezuo recommended a low-salt version of the Dietary Approaches to Stop Hypertension (DASH) diet, alongside diuretics. He also identified combinations of diuretics and calcium channel blockers, or other appropriate medicines, including angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs) and beta-blockers, as treatment options depending on the patient’s blood pressure and clinical circumstances.

He explained that combination therapy may be necessary when blood pressure is more than 15/10 mmHg above the treatment target, while selected patients may be managed with a diuretic or calcium channel blocker as monotherapy. He cautioned that ACEIs, ARBs and beta-blockers may be less effective than diuretics or calcium channel blockers when used alone in some Black patients.

“The pathogenesis of HBP in Blacks is multifactorial, involving interactions among obesity, salt sensitivity and activation of the renin-angiotensin-aldosterone system (RAAS), among other factors,” he said.

He added that understanding how these factors influence blood pressure would help guide the development of treatment protocols and future therapies. According to him, dietary changes, lifestyle modifications and measures to address barriers to blood pressure control should be incorporated into all treatment regimens.

Also speaking with Pharmanewsonline in a telephone interview, Dr Tricia Cookey-Gam Nwamaka, Deputy Director, Obstetrics and Gynaecology Department, University of Port Harcourt Teaching Hospital (UPTH), highlighted the role of pharmacists in hypertension management through pharmaceutical care, medication management and patient counselling.

She explained that the ultimate goal of pharmaceutical care is to optimise medication use and improve health outcomes by identifying and resolving actual or potential drug therapy problems, as well as preventing potential problems from developing into actual ones that could compromise treatment outcomes.

Defining hypertension as persistently elevated blood pressure, with systolic pressure of 140 mmHg or above and/or diastolic pressure of 90 mmHg or above in adults, Nwamaka urged pharmacists to provide appropriate counselling to patients, given that hypertension often requires long-term medication and sustained lifestyle management.

She said counselling should emphasise the potential damage uncontrolled blood pressure can cause to major organs, the importance of adhering to prescribed medication and the need to take medicines consistently at the recommended times. She added that diuretics are often taken in the morning to minimise frequent urination at night, although patients should follow their prescribed treatment instructions.

Nwamaka also cautioned against combining conventional medicines with herbal preparations without professional advice. She noted that ACE inhibitors may cause a persistent dry cough, while methyldopa may cause postural hypotension and requires careful consideration in patients with a history of depression. She added that some antihypertensive medicines may cause sexual side effects in men, underscoring the importance of individualised treatment and professional counselling.